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Health Policy Plan. 2017 Apr 1;32(3):320-328. doi: 10.1093/heapol/czw129.

Ethiopia's health extension workers use of work time on duty: time and motion study.

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Department of Global Health and Population/Harvard T.H. Chan School of Public Health, Boston, MA, USA.
John Snow Research and Training Institute, Inc., International Division, Addis Ababa, Ethiopia.
Department of Health Policy & Management, Yale School of Public Health, New Haven, CT, USA.
Department of Health Policy & Management Global Health Leadership Institute at Yale University, New Heaven, CT, USA.
Department of Health Policy & Management Yale Global Health Leadership Institute, Yale University, New Haven, CT, USA.


Ethiopia implemented an innovative community-based health program, called the health extension program, to enhance access to basic health promotion, disease prevention and selected curative services by establishing health posts in every village, also called kebeles, with average of 5000 people, staffed with two health extension workers (HEWs). This time and motion study was done to estimate the amount of time that HEWs spend on various work duties and to explore differences in urban compared with rural settings and among regions. A total of 44 HEWs were observed for 21 consecutive days, and time and motion data were collected using tablet computers. On average, HEWs were on duty for 15.5 days out of the 21 days of observation period, and on average, they stayed on duty for about 6 hours per day. Out of the total observed work time, the percentages of total time spent on various activities were as follows: providing health education or services (12.8%); participating in meetings and giving trainings (9.3%); conducting community mapping and mobilization (0.8%); recordkeeping, reporting, managing family folders (13.2%); managing commodities and supplies (1.3%); receiving supervision (3.2%); receiving training (1.6%); travel between work activities (15.5%); waiting for clients in the health post (or health centre in urban settings) (24.9%); building relationships in the community (13.3%); and other activities that could not be meaningfully categorized (4%). The proportion of time spent on different activities and the total time worked varied significantly between rural and urban areas and among the regions (at P < 0.05). Findings of this study indicate that only a minority of HEW time is spent on providing health education and services, and substantial time is spent waiting for clients. The efficiency of the HEW model may be improved by creating more demand for services or by redesigning service delivery modalities.


Community health workers; demand; health extension worker; motion; time

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